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Invasive meningococcal disease (IMD) remains a rare but severe condition associated with high mortality and a significant risk of long-term sequelae. Despite global vaccination efforts, the epidemiology of Neisseria meningitidis continues to evolve, with serogroup B (MenB) representing the predominant cause of IMD in many high-income countries. This consensus document reviews current evidence on MenB epidemiology and the role of the multicomponent meningococcal serogroup B vaccine (4CMenB), with a focus on immunogenicity, strain coverage, real-world effectiveness, and remaining challenges. Protein-based MenB vaccines have overcome the limitations of polysaccharide approaches, demonstrating robust immunogenicity across age groups. Real-world data confirm substantial vaccine effectiveness, particularly in infant immunization programs and outbreak settings, with significant reductions in disease incidence. For example, in England in the 3 years after vaccine introduction, MenB IMD incidence declined by 75% in immunized infants compared to unvaccinated controls. Adjusted vaccine efficacy was 52.7% after the two-dose primary series and 59.1% following the booster dose, highlighting the contribution of the booster. However, protection is influenced by antigenic variability among circulating strains, resulting in incomplete and geographically variable coverage. In addition, antibody waning over time and the limited impact on nasopharyngeal carriage reduce the potential for long-term and indirect protection. These factors highlight the need to optimize vaccination strategies, including the timing of booster doses, particularly in adolescents, and the role of vaccination in different epidemiological contexts. In this regard, it is not precisely defined whether infants who were immunized in the first year of life need a booster dose in the preschool period, especially in countries with a high incidence of MenB disease. Moreover, it is not established whether and when adolescents who were vaccinated both in infancy and during the preschool period need a booster dose. Economic considerations and variability in national immunization policies further contribute to heterogeneity in vaccine implementation. Emerging evidence suggests possible cross-protection against other meningococcal serogroups and Neisseria gonorrhoeae, although findings remain inconsistent across different risk groups and do not allow us to recommend 4CMenB vaccine beyond MenB IBD prevention. 4CMenB is an effective tool for preventing MenB IMD, although further studies are needed. Future strategies should prioritize age-targeted boosting and enhanced genomic surveillance to maximize impact.

Irrespective of intensive global efforts to reduce under-five mortality, it remains a significant public health concern. Understanding the causes and trends of under-five mortality is essential for guiding targeted interventions, assessing the effectiveness of public health strategies, and monitoring changes in mortality over time. The health and demographic surveillance system is one of the preferred sources to study the cause of under-five mortality. This study aims to analyse the causes and trends of under-five deaths in Southwest Ethiopia using Gilgel-Gibe Health and Demographic Surveillance System (GGHDSS) database. GGHDSS is an open, dynamic cohort that was established in 2005. Fifteen years of mortality data and seven years of Verbal Autopsy (VA) data were extracted from the GGHDSS database for this study. The VA data are part of the fifteen year mortality dataset, in which causes of death were determined through the VA method. After extracting the data from MYSQL and OpenHDS, it was exported to Excel for further cleaning. Finally, the cleaned data were exported to R statistical software for analysis and visualization. Neonatal, infant, and under-five mortality trends were analysed and the proportion of cause specific deaths were identified from the VA data. Between 2005 and 2019, 28, 811 children, 13931 (48.35%) female and 14880 (51.65%) male, were born alive and registered in the GGHDSS, among which 1828 (6.34%) of them died before celebrating their fifth birthday. The overall under-five mortality rate was 63.4 (95% CIs; 60.6, 66.3) per 1000 live births while neonatal and infant mortality rates were 30(95% CIs; 28.1, 32) and 50.2 (95% CIs; 47.6, 52.7), respectively. The mortality rate during the surveillance years showed a declining trend among neonatal, infant, and overall under-five children, with average slopes of -2.49, -4.56, and -7.24, respectively. From 1070 under-five deaths captured by the VA method in GGHDSS during 2009-2016, 596 (55.7%) were male and 474 (44.30%) were female. The most common causes of neonatal death were birth asphyxia and perinatal respiratory disorders, bacterial sepsis, and prematurity including respiratory distress. In the post-neonatal period, the most common causes of death were acute lower respiratory infections (including pneumonia and acute bronchitis), intestinal infectious diseases including diarrheal diseases, and malaria. Severe malnutrition, intestinal infectious diseases, and acute lower respiratory infections were responsible for more than half of the deaths among children between 12 and 59 months of age. Under-five mortality has shown a significant declining trend between 2005 and 2019 at the study setting. Birth asphyxia, neonatal infections, and prematurity were among the most common causes of neonatal deaths, whereas infectious diseases and malnutrition were the main causes of death beyond the neonatal period. Strengthening perinatal and neonatal care, improving prevention and management of childhood infections, and enhancing early nutritional interventions are needed to reduce under-five mortality.

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Cardiovascular disease (CVD) mortality is rising in Sierra Leone, but the health-system drivers of this trend are not well characterised. We mapped health-system barriers and facilitators for CVD care in Sierra Leone using a systems lens tied to universal health coverage (UHC). We conducted a scoping review following PRISMA-ScR guidelines. We searched MEDLINE, Embase, Scopus, Global Health, and African Journals Online (1 Jan 2000 - 10 May 2025), Of 498 unique records, we included 40 sources reporting CVD-relevant data. Findings were mapped to WHO health-system building blocks, and synthesised narratively. Our findings show a health system shaped by path dependence: investments in infectious disease programmes have strengthened vertical delivery platforms with limited integration of non-communicable disease services. Facility readiness averaged 41% for HIV services versus 16.8% for cardiovascular care. An urban risk paradox was identified: urbanisation increased the odds of hypertension (OR 1.46) and diabetes (OR 1.84), while primary care infrastructure remained more oriented toward rural maternal health. Service delivery was undermined by diagnostic gaps; limited access to neuroimaging for stroke was associated with a threefold increase in mortality. High out-of-pocket costs narrowed effective coverage toward wealthier groups, and recurrent medicine stockouts reinforced distrust and disengagement from formal care. Scalable enablers included task-sharing, digital tools, pooled procurement, and community engagement. Strengthening task-shared primary care, ring-fenced CVD budgets, pooling drug procurement, and improving digital infrastructure could accelerate UHC-effective coverage in Sierra Leone. Evidence on cost-effectiveness and socio-cultural determinants remains limited and should guide implementation research. Heart diseases are a major cause of death in Sierra Leone. However, the health system is still mainly designed to respond to infectious diseases including malaria and HIV, rather than long-term conditions like heart disease. In this review, we analysed 40 studies to understand why people often struggle to get proper heart disease care. We found that health facilities were much better prepared to deliver HIV services (41% readiness) than heart disease services (17% readiness). High blood pressure and other heart disease risks are increasing, especially with urbanisation. However, services for heart disease are not always available where people need them most. Many people still face long travel distances, limited services at nearby clinics, and poor availability of medicines, equipment, and trained staff. Unlike HIV care, heart disease care often requires out-of-pocket payments, which delays treatment until emergencies such as stroke happen. Solutions include adapting HIV infrastructure for heart disease care and lowering costs.

This study investigated the impact of heat on the risk of hospital admission due to a range of health conditions in England. We used records of over 4 million hospital admissions in the summer months between 2008 and 2019, to construct daily time series of admissions in 32 837 census areas. Coupled with high-resolution environmental data, we conducted a case time-series analysis using distributed-lag non-linear models to measure the lagged relationship between summertime temperature and risk of admission for a broad set of health conditions. We derived the relative risks of admission at the 99th compared with the 50th temperature percentile to understand the effect of extreme heat in each locality. The adult population of England (aged 18 years and older). Unplanned National Health Service (NHS) in-patient hospital admissions for cardiovascular, respiratory, genitourinary, metabolic and infectious diseases, along with their subcategories. These conditions contributed more than 3.7 million admissions, of which over 1.5 million (42%) were for those aged 75 years and over. More than 80% of admissions were for respiratory, cardiovascular or genitourinary illness, which collectively contributed 3.1 million hospital admissions. There was clear evidence of an increased risk of hospital admission for many conditions, including acute renal failure (1.37, 95% CI 1.32 to 1.42), metabolic disorders (1.28, 95% CI 1.24 to 1.32), infectious and parasitic diseases (1.06, 95% CI 1.04 to 1.08), pneumonia (1.07, 95% CI 1.05 to 1.09) and chronic obstructive pulmonary disease (1.08, 95% CI 1.05 to 1.10). The evidence was less clear for asthma and diabetes, while there were negative associations for many cardiovascular conditions. There was a clear age gradient in heat-related admissions, with older people facing the greatest risk of admission. These findings highlight the widespread effect of extreme heat across a range of health conditions, in addition to mortality, and have implications for public health planning in our changing climate.

Giardiasis is one of the most common enteric protozoal infections worldwide. It is frequently reported as an enteric parasitic infection in the United States of America (USA) and Europe, whereas reported incidence in Japan is substantially lower. This study characterized age-specific, geographic, and temporal patterns of reported giardiasis incidence in Japan, the USA, and Europe using publicly available surveillance data. This retrospective study analyzed surveillance data from the National Institute of Infectious Diseases (NIID) in Japan, the Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC) to describe epidemiological patterns, possible explanatory factors, and temporal trends before and during the COVID-19 pandemic. Annual trends were examined using all available surveillance years: 2007-2023 for Japan and Europe and 2007-2022 for the USA. Age-specific patterns were compared between the pre-pandemic (2017-2019) and pandemic (2020-2022) periods, and geographic patterns were examined using available regional data. Incidence rates in the USA and Europe were approximately 5 per 100,000 population, whereas reported incidence in Japan remained below 0.1 per 100,000. Age-specific patterns differed: incidence peaked in children aged 0-14 years in Europe, and in children aged 0-4 years and adults aged 25-39 years in the USA, whereas in Japan, incidence was highest among adults aged 25-44 years and relatively high among those aged ≥65 years. Geographic patterns also differed, with higher incidence in Tokyo, Nordic and Baltic countries and selected European countries, and New England and Midwestern states. Annual incidence was significantly lower in the COVID-19-onset period than in the pre-COVID-19 period across all regions. These findings suggest that exposure patterns and possible explanatory factors differ by region and age group, highlighting the importance of region- and age-specific prevention strategies.

Tuberculosis (TB) is the leading global cause of death from a single infectious agent. Recent reductions in global health funding have threatened TB control, making comprehensive assessment of TB, HIV-related TB, and drug-resistant TB burdens before these disruptions essential for shaping effective responses. The WHO End TB Strategy sets targets of a 95% reduction in TB deaths and a 90% reduction in TB incidence between 2015 and 2035. Using results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, this study aims to assess the burden of TB and multidrug-resistant TB (MDR-TB) across 204 countries and territories, and to evaluate progress towards the WHO End TB incidence and mortality targets. We quantified TB mortality using the Cause of Death Ensemble modelling platform with global vital registration, surveillance, verbal autopsy, and minimally invasive tissue sampling data. For TB morbidity estimation, we simultaneously modelled incidence, prevalence, and mortality by age and sex using DisMod-MR 2.1. A population attributable fraction (PAF) approach was applied to stratify morbidity and mortality estimates by HIV and drug-resistance status. We also calculated disability-adjusted life-years (DALYs) as the sum of years of life lost and years lived with disability. For the risk factor analysis, a comparative risk assessment framework was used and PAFs were derived for alcohol use, smoking, and high fasting plasma glucose to determine the proportion of TB burden associated with these risk factors. In 2023, there were an estimated 9·11 million (95% uncertainty interval 8·04-10·3) incident cases of all-form TB, 1·22 million (0·98-1·49) deaths, and 54·6 million (43·8-65·5) DALYs globally. HIV-related TB comprised 781 000 (690 000-879 000) incident cases and 210 000 (142 000-279 000) deaths, contributing 11·0 million (7·56-14·3) DALYs. MDR-TB accounted for 466 000 (198 000-1 080 000) incident cases, 102 000 (31 700-238 000) deaths, and 3·96 million (1·31-9·01) DALYs. From 2015 to 2023, global all-form TB incidence rates declined by 19·2% (17·8-20·5) and deaths declined by 22·6% (4·7-35·7); declines were larger for drug-susceptible TB than for MDR-TB. Sub-Saharan Africa and south Asia had the highest mortality burdens in 2023; reductions in all-form TB incidence and mortality were uneven between 2000 and 2023, with limited progress in both measures in Latin America and the Caribbean. Removing smoking, alcohol use, and high fasting plasma glucose would reduce global TB deaths to 768 000 (592 000-970 000) and DALYs to 34·9 million (27·8-43·8) in 2023; MDR-TB deaths would decrease to 77 200 (23 400-183 000) and DALYs to 3·12 million (1·03-7·29). Global progress towards WHO End TB targets is disparate and fragile. Although many regions achieved meaningful gains, others have stagnated in recent years. The complexity of TB prevention is amplified by divergent MDR-TB trends, the persistent burden of HIV, and growing exposure to modifiable risk factors. Recent volatility in global health financing threatens to further destabilise this vulnerable epidemiological landscape; concerted action is urgently needed to temper disruptions and preserve progress. Gates Foundation.

To study the efficacy of fosfomycin trometamol (FT) as prophylaxis for recurrent urinary tract infections (UTI) in a population not targeted by guidelines. Retrospective, monocenter study of patients taking FT prophylaxis for recurrent UTI. We compared the incidence of UTI during the six months prior to and the six months following the initiation of prophylactic treatment with FT. a total of 86 patients were enrolled in the study, including 20 men and 66 women, with a median age of 56.5 years [44-70]. Forty-one had underlying urological diseases, and 24 were immunocompromised, including 16 kidney transplant recipients. FT prophylaxis was associated with a dramatic decrease in the incidence of UTI on multivariate analysis, with an incidence rate ratio of 0.15 [0.11-0.20] in women, and 0.05 [0.02-0.16] in men. Adverse events were reported by 12(13.9%) patients, leading to FT discontinuation in 3(3.4%). FT prophylaxis was associated with a 85-95% reduction in the incidence of UTI in patients with recurrent UTI and predisposing conditions.

Cerebral organoids (COs) are valuable for studying neurodegenerative diseases and pathogens, but their limited microglia pose challenges. Here, we present a protocol to generate organoids with physiologically relevant microglia (CO-iMs). We describe steps for differentiating induced pluripotent stem cells (iPSCs) into mesoderm, seeding embryoid bodies (EBs), and harvesting hematopoietic progenitor cells (HPCs). We detail procedures for co-culturing HPCs and iPSCs to generate CO-iMs, followed by their infection and treatment. The model provides a platform to study viral infections and neuroinflammation. For complete details on the use and execution of this protocol, please refer to Narasipura et al.1.

Although the availability of high-quality surveillance data is critical to inform efforts to reduce the major burden of bloodstream infections (BSIs), there remains a paucity of comprehensive population-based investigations worldwide. To describe the rationale and protocol development of the Queensland BSI (QBSI) study. Population-based laboratory surveillance was performed for all BSIs occurring in the publicly funded healthcare system in Queensland, Australia during 2000-2023. Linkages to statewide hospital admissions and vital statistics databases have been performed to determine clinical determinants and mortality outcomes for a minimum of 1 year post-BSI. Standardised definitions were developed to identify incident episodes of BSI and classify them according to type of onset. More than 3.7 million blood cultures were processed during the study period of which a total of 444,279 positive blood cultures were initially identified. Hospital registrations statewide within two years before index culture and one year after were included (n = 2,425,688 with 10,341,136 associated International Statistical Classification of Diseases (ICD) codes during 2000-2023). Comorbidities were classified using previously developed ICD-based algorithms for adults and children and all-cause case-fatality at 30, 90 and 365 days was chosen as the primary outcome measure. The QBSI study is an evolving program designed to comprehensively examine the epidemiology and outcome of BSIs occurring among residents of this large Australian state. Our aim is to share our experiences to support the development of collaborating centres elsewhere to accelerate epidemiology knowledge and ultimately reduce the major burden due to BSI in populations worldwide.

Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021-30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). In 2023, there were 50·9 million (95% UI 46·1-56·1) road injury incident cases, 1·34 million (1·04-1·58) deaths, and 75·3 million (59·8-89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10-39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9-39·7) and mortality decreased by 32·3% (6·1-49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7-56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1-7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9-947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Gates Foundation.

Vector-borne diseases (VBDs) are an increasing threat to animal and human health worldwide. Due to the complexity of VBD transmission and ecology, informing responses to VBDs can be challenging. A One Health approach provides a powerful framework for addressing these threats, but its effectiveness depends on timely access to and integration of diverse and often fragmented data categories. Here we outline three key community actions: applying global metadata and data standards, depositing data into global repositories and responsible shared data usage, which can enhance VBD data sharing. We highlight how these data-sharing practices allow for the development of new informatic infrastructure, established by the One Health VBD Hub project, to facilitate analyses and ultimately enhance our ability to provide timely responses to endemic and emerging VBD threats.

People diagnosed with tuberculosis (TB) after death (postmortem) experience the ultimate diagnostic delay. We aimed to identify social and health factors associated with postmortem TB diagnosis in England. We conducted a national retrospective cohort study using routinely collected surveillance data from the UK Health Security Agency's National TB Surveillance System (NTBS) between 1 January 2010 and 31 December 2022. Of 72 058 people notified with TB, 19 without a recorded diagnostic outcome were excluded, leaving 72 039 for analysis. The primary outcome was postmortem versus antemortem TB diagnosis. Associations were assessed using univariate and multivariable logistic regression. Of 72 039 participants, 574 were diagnosed postmortem, averaging 0.84 cases per week. With the exception of age 0-4 years (adjusted odds ratio, aOR, 5.36 (95%CI 1.62-17.67), the likelihood of postmortem diagnosis increased markedly with age, from aOR 2.96 (95% CI 1.14 to 7.64) at age 35-39 years to 85.67 (95% CI 32.34 to 226.97) at age ≥90 years. Male sex (aOR 1.62; 95% CI 1.31 to 2.00), UK birth (aOR 1.53; 95% CI 1.10 to 2.14), alcohol misuse (aOR 3.08; 95% CI 1.30 to 7.30) and drug misuse (aOR 2.48; 95% CI 1.21 to 5.12) were associated with increased odds of postmortem diagnosis. Compared with London, all other National Health Service regions had increased odds of postmortem diagnosis. BCG vaccination (aOR 0.49; 95% CI 0.29 to 0.84) and pulmonary TB (aOR 0.60; 95% CI 0.48 to 0.75) were associated with lower odds. Postmortem TB diagnosis in England is frequent and associated with being in early childhood (0-4 years), older age, male sex, UK birth, substance misuse and notification outside London. Recognising postmortem TB diagnosis as a 'never event' and developing targeted interventions to reduce diagnostic delays are essential to achieve England's TB elimination goals.

This study aimed to describe epidemiology and management of severe surgical site infections (SSIs) following cochlear implantation (CI) and to identify risk factors. A retrospective monocentric study of all CI procedures was performed at our tertiary referral centre between January 2018 and December 2023. Data on patient demographics, clinical features and postoperative infections were collected. Severe SSIs were defined as abscess, skin flap necrosis or device extrusion requiring hospitalisation and/or IV antibiotics. Univariate and multivariate analyses were performed to identify risk factors. Of the 383 CIs, 3.6% (n&#xa0;=&#xa0;14) developed severe SSIs. A salvage surgery was attempted in 85.7% of cases and the device explantation rate was of 71.4%. Staphylococcus aureus and Pseudomonas aeruginosa were the most identified pathogens. Chronic otorrhea was identified as a statistically significant risk factor for severe SSI (p&#xa0;<&#xa0;0.001). No significant associations were found with obesity, tobacco use, diabetes, bilateral implantation or implantation renewal. Severe SSIs following CI are rare but challenging to treat, with a poor outcome. Chronic otorrhea appears to be a significant risk factor. Early intervention with IV antibiotics followed by salvage surgery may help avoid explantation.

The epidemiology of Aspergillus-related chronic lung disease remains poorly defined. We aimed to characterise the local burden at Imperial College Healthcare National Health Service Trust, London, across a 10-year period (2014-2024). Electronic health records were reviewed to identify individuals tested for serological markers of Aspergillus species infection after which thoracic CT scans were reviewed for features of Aspergillus-related chronic lung disease. Patients were classified into diagnostic categories based on definitions provided in the recent British Thoracic Society Clinical Statement. In total, 334 individuals met criteria for serologic allergic bronchopulmonary aspergillosis (sABPA), 145 for ABPA, 74 for chronic pulmonary aspergillosis (CPA), 38 for simple aspergilloma and 11 with CPA-ABPA overlap. Serological responses varied: ABPA patients had higher median Aspergillus fumigatus-specific immunoglobulin (Ig)E titres (7.52 kUA/L, vs 1.94 kUA/L, p<0.05) and a greater proportion were positive for Aspergillus antibody (IgG) or precipitins (62.5% vs 32.9%, p<0.05) compared with sABPA. CPA patients had lower median total IgE (94 vs 1494&#x2009;IU/mL, p<0.05) and A. fumigatus-specific IgE (2.24 vs 7.52&#x2009;kUA/L, p<0.05) than ABPA patients. There was a wide spectrum of radiological presentations across diagnostic categories. While case numbers are likely underestimated, our findings highlight a substantial and heterogeneous local burden. This improved understanding of local epidemiology will inform our local service development.

Necrotising fasciitis (NF) requires rapid diagnosis to prevent morbidity and mortality. Yet clinicians rely heavily on imaging to help guide diagnosis, but type II NF is caused by non-gas producing organisms. Thus, the aim of this study was to assess computer topography (CT) imaging findings of type I compared to type II NF. This was a retrospective study conducted by reviewing medical records with NF from 1/1/2020 to 12/31/2024 at a single medical centre. The presence of air on CT images was evaluated by reviewing radiology reports and manual review of imaging. Comparisons were made on imaging findings for type I compared to type II NF as well as based on location. A total of 367 patients had type I NF and 90 patients had type II NF. When comparing the proportion of NF with gas seen on imaging (total 75.5%), the type I cohort had a statistically significant higher rate of gas present in the soft tissues (91.8% compared to 7.8% p&#x2c2;0.0001). When this was separated by location there was a statistically significant difference in the rates of imaging with gas in all locations except the foot. This study demonstrates that reliance on CT imaging to evaluate gas in soft tissues is not advantageous for diagnosing type II NF. Thus, this study reinforces that NF is a clinical diagnosis and CT findings without gas in the soft tissues do not exclude NF.

Rapid point-of-care tests (POCTs) are increasingly used to support clinical decision making and appropriate antibiotic prescribing. Whilst a few studies have explored healthcare workers' views on using POCTs in paediatric febrile illness, little is known about the perspectives of children and young people (CYP) who may undergo these tests. This study aimed to explore CYP acceptability and perceptions of POCTs. Three focus groups were conducted with CYP aged 12-18 years, from Young Persons' Advisory Groups, at university hospitals in Newcastle and London, UK. Data were collected using questionnaires and semi-structured group discussions. Qualitative thematic analysis was undertaken to identify key themes relating to POCT acceptability, availability and perceived impact. A total of 54 CYP participated (10 in 2017, 25 in 2018, and 19 in 2025). The majority supported the implementation of POCT tests, provided they are accessible through community or hospital healthcare services. Key themes included altruism, test reliability, and the need for healthcare advice or review in-person following the test. CYP prefer non-invasive tests such as saliva-based sampling, over blood tests, and reported aversion to urine samples. POCTs were viewed as a means of improving assessment of unwell children and potentially reducing the burden on healthcare services if results were reassuring. CYP are in favour of using POCTs to facilitate and improve the care they receive. They recognised the potential benefits they might have, but highlighted important limitations particularly regarding availability, interpretation and potential impact on the wider healthcare system.

Respiratory Syncytial Virus (RSV) can cause severe illness in adults, leading to respiratory and non-respiratory complications, functional decline, hospitalisation, and death. This study describes French patients aged &#x2265;50&#x2009;years hospitalised with RSV (2015-2022) and their care pathways, including hospitalisation and outpatient healthcare use and costs. Data were extracted from the French National Health Data System (SNDS). Patients were classified into four risk groups (high: immunocompromised; medium: underlying predisposition; other; no comorbidities) and four age groups (50-59, 60-64, 65-74, &#x2265;75&#x2009;years). Healthcare use (laboratory tests, imaging, pharmacy, GP visits, rehospitalisations) and costs were analysed across three periods: 60-30&#x2009;days pre-hospitalisation (reference period), index hospitalisation, and 30&#x2009;days post-hospitalisation. We identified 15,509 RSV-related hospitalisations for 15,169 adults &#x2265;50&#x2009;years. Median age was 80&#x2009;years, with age &#x2265;75&#x2009;years comprising 61.7% of the cohort. 15.9% were high risk, 71.4% medium risk, 4.8% other, and 7.8% had no comorbidities. Intensive care was required in 25.4% of cases. In-hospital mortality was 8.5%, with an additional 3.8% dying within 30&#x2009;days post-discharge. Rehospitalisation occurred in 17.8% of patients, nearly half for cardiorespiratory causes. Median index hospitalisation cost was &#x20ac;4,252 (Q1; Q3: &#x20ac;3,077; &#x20ac;7,007), and post-hospitalisation costs increased across all ages and risk profiles compared to the reference period. RSV imposes a substantial hospitalisation and cost burden in adults &#x2265;50&#x2009;years, especially older patients and those with comorbidities. Expanded preventive vaccination strategies could help reduce this impact.

Following the introduction of direct-acting antivirals (DAAs), elimination of hepatitis C virus (HCV) became a target of the World Health Organisation (WHO) in 2016. Denmark had a HCV prevalence of 0.21% in 2016, and in 2018, unrestricted access to DAAs was introduced together with intensified testing strategies. To estimate adult HCV diagnostic and treatment coverage in Denmark by the end of 2022. Four national HCV source registers (laboratory reports, surveillance notifications, treatment database and hospital diagnoses) were merged. Capture-recapture analysis was used to estimate diagnosed individuals not identified in the registers, and estimates were adjusted for treated patients. The undiagnosed population was estimated using HCV testing data among high-risk individuals recorded in the Register for Treatment of Drug Use and compared with Danish studies on the diagnosed fraction of newly detected HCV cases. Across the four registers, 1,649 valid records of HCV-infected adults alive and resident in Denmark were identified. Capture-recapture analysis estimated a total of 1,700 (95% CI: 1,677-1,739) diagnosed individuals. With an undiagnosed fraction of 22-32%, the total HCV-infected population was estimated at 2,471-2,582 individuals, corresponding to a prevalence of 0.05-0.06% by the end of 2022. Compared to the 2016 baseline 82% had been diagnosed and 77% of diagnosed patients had been treated for HCV. HCV prevalence in Denmark has declined substantially, and with ongoing national initiatives to test and treat the remaining HCV patients we are likely to achieve WHO targets of diagnostic coverage and treatment before 2030.